Provider Demographics
NPI:1790087492
Name:HOSPITAL PEDIATRICO UNIVERSITARIO
Entity Type:Organization
Organization Name:HOSPITAL PEDIATRICO UNIVERSITARIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VILMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-777-3535
Mailing Address - Street 1:CARR # 22 BO. MONACILLOS
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00935
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:
Practice Address - Street 1:HOPU BO MONACILLOS CARR #22 CENTRO MEDICO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12751OtherSTATE LICENCE